Skip to main content

Advertisement

SpringerLink
Log in

Effects of Carbonated Liquids on Oropharyngeal Swallowing Measures in People with Neurogenic Dysphagia

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

Aspiration is common in adults with neurogenic dysphagia and pharyngeal delay. This can lead to dehydration, malnutrition, and aspiration pneumonia. Diet modifications aimed at reducing thin liquid aspiration are partially successful or unpalatable or both. Carbonated liquids show some potential in influencing swallowing behavior. However, there is a paucity of evidence to support this intervention. This study compares the effects of carbonated thin liquids (CTL) with that of noncarbonated thin liquids (NCTL) on oropharyngeal swallowing in adults with neurogenic dysphagia and examines the palatability of the CTL stimulus. Seventeen people with pharyngeal delay attended for videofluoroscopy (VFSS). Outcome measures were oral transit time (OTT), pharyngeal transit time (PTT), stage transition duration (STD), initiation of the pharyngeal swallow (IPS), penetration-aspiration scale (PENASP), and pharyngeal retention (PR). A modification of Quartermaster Hedonic Scale (AQHS) was employed to assess palatability of the CTL. CTL vs. NCTL significantly decreased penetration and aspiration on 5-ml (P = 0.028) and 10-ml (P = 0.037) swallows. CTL had no significant effect on OTT, PTT, IPS, and PR for any volume of bolus. Only one participant disliked the CTL stimulus. These findings support the hypothesis that oropharyngeal swallowing can be modulated in response to sensory stimuli. Implications for research and clinical practice are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Gates J, Hartnell GG, Gramigna GD. Videofluoroscopy and swallowing studies for neurologic disease: a primer. RadioGraphics. 2006;26:e22.

    Article  PubMed  Google Scholar 

  2. Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1991;30:744–8.

    Article  Google Scholar 

  3. Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36:2756–63.

    Article  PubMed  Google Scholar 

  4. Campbell-Taylor I. Oropharyngeal dysphagia in long-term care: misperceptions of treatment efficacy. J Am Med Dir Assoc. 2008;9:523–31.

    Article  PubMed  Google Scholar 

  5. Kuhlemeier KV, Palmer JB, Rosenberg D. Effect of liquid bolus consistency and delivery method on aspiration and pharyngeal retention in dysphagia patients. Dysphagia. 2001;16:119–22.

    Article  PubMed  CAS  Google Scholar 

  6. Finestone HM, Foley NC, Woodbury GM, Greene-Finestone L. Quantifying fluid intake in dysphagic stroke patients: a preliminary comparison of oral and nonoral strategies. Arch Phys Med Rehabil. 2001;82:1744–6.

    Article  PubMed  CAS  Google Scholar 

  7. Logemann J, Lindbald AS, Brandt D, et al. A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson’s disease. J Speech Lang Hear Res. 2008;51:173–83.

    Article  PubMed  Google Scholar 

  8. Bartoshuk L, Duffy V, Leder S, Snyder D. Oral sensation: genetic and pathological sources of variation. Dysphagia. 2003;14:3–9.

    Google Scholar 

  9. Jean A. Brain stem control of swallowing: neuronal network and cellular mechanisms. Physiol Rev. 2001;81:929–69.

    PubMed  CAS  Google Scholar 

  10. Logemann JA. Pre-swallow sensory input: its potential importance to dysphagic patients and normal individuals. Dysphagia. 1996;11:9–10.

    Article  PubMed  CAS  Google Scholar 

  11. Martin RE. Neuroplasticity and swallowing. Dysphagia. 2009;24:218–29.

    Article  PubMed  Google Scholar 

  12. Miller AJ. The neurobiology of swallowing and dysphagia. Dev Disabil Res Rev. 2008;14:77–86.

    Article  PubMed  Google Scholar 

  13. Mistry S, Hamdy S. Neural control of feeding and swallowing. Phys Med Rehabil Clin N Am. 2008;19:709–28.

    Article  PubMed  Google Scholar 

  14. Robbins J, Butler SG, Daniels SK, et al. Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. J Speech Lang Hear Res. 2008;51:S276–300.

    Article  PubMed  Google Scholar 

  15. Buettner A, Beer A, Hannig C, Settles M, Schieberle P. Physiological and analytical studies on flavor perception dynamics as induced by the eating and swallowing process. Food Qual Pref. 2002;13:497–504.

    Article  Google Scholar 

  16. Carstens E, Carstens MI, Dessirier JM, O’Mahony M, Simons CT, Sudo M, Sudo S. It hurts so good: oral irritation by spices and carbonated drinks and the underlying neural mechanisms: Short communication. Food Qual Pref. 2002;13:431–43.

    Article  Google Scholar 

  17. Chandrashekar J, Yarmolinsky D, Buchholtz L, Oka Y, Sly W, Ryba NJP, Zuker CS. The taste of carbonation. Science. 2009;326:443–5.

    Article  PubMed  CAS  Google Scholar 

  18. Duffy VB. Variation in oral sensation: implications for diet and health. Curr Opin Gastroenterol. 2007;23:171–7.

    Article  PubMed  CAS  Google Scholar 

  19. Green BG. Oral chemesthesis: an integral component of flavor. In: Taylor A, Roberts D, editors. Flavor perception. Oxford: Blackwell Publishing; 2004. p. 151–71.

    Chapter  Google Scholar 

  20. Negoias S, Visschers R, Boelrijk A, Hummel T. New ways to understand aroma perception. Food Chem. 2008;108:1247–54.

    Article  CAS  Google Scholar 

  21. Logemann JA, Pauloski BR, Colangelo L, Lazarus C, Fujiu M, Kahrilas PJ. Effects of a sour bolus on oropharyngeal swallowing measures in patients with neurogenic dysphagia. J Speech Hear Res. 1995;38:556–63.

    PubMed  CAS  Google Scholar 

  22. Pelletier CA, Lawless HT. Effect of citric acid and citric acid-sucrose mixtures on swallowing in neurogenic oropharyngeal dysphagia. Dysphagia. 2003;18:231–41.

    Article  PubMed  Google Scholar 

  23. Pelletier CA, Dhanaraj GE. The effect of taste and palatability on lingual swallowing pressure. Dysphagia. 2006;21:1–8.

    Article  Google Scholar 

  24. Bulow M, Olsson R, Ekberg O. Videoradiographic analysis of how carbonated thin liquids and thickened liquids affect the physiology of swallowing in subjects with aspiration of thin liquids. Acta Radiol. 2003;44:366–72.

    PubMed  CAS  Google Scholar 

  25. Jennings KS, Siroky D, Jackson CG. Swallowing problems after excision of tumors of the skull base: diagnosis and management in 12 patients. Dysphagia. 1992;7:40–4.

    Article  PubMed  CAS  Google Scholar 

  26. Krival CR. Effects of carbonated vs. thin and thickened liquids on swallowing in adults with neurogenic oropharyngeal dysphagia. Doctoral dissertation, University of Cincinnati; 2007. Available at http://etd.ohiolink.edu/send-pdf.cgi/KRIVAL%20CATHERINE%20KATE%20RACHEL.pdf?acc_num=ucin1186623264. Retrieved February 5, 2009.

  27. Miura Y, Morita Y, Koizumi H, Shingai T. Effects of taste solutions, carbonation, and cold stimulus on the power frequency content of swallowing submental surface electromyography. Chem Senses. 2009;34:325–31.

    Article  PubMed  Google Scholar 

  28. Newman L, Armstrong R, Rogers T, et al. The effect of carbonation on sensory dysphagia in the pediatric population. Dysphagia. 2001;16:146–50.

    Google Scholar 

  29. Nixon TS. Use of carbonated liquids in the treatment of dysphagia. Network: a newsletter of dietetics in physical medicine and rehabilitation. New York: American Dietetic Association; 1997.

    Google Scholar 

  30. Steele CM, Miller AJ. Sensory input pathways and mechanisms in swallowing: a review. Dysphagia. 2010;25:323–33.

    Article  PubMed  Google Scholar 

  31. Robey R. A five-phase model for clinical-outcome research. J Commun Disord. 2004;37:401–11.

    Article  PubMed  Google Scholar 

  32. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175–91.

    Article  PubMed  Google Scholar 

  33. Gothoskar AV, Kshirsagar SJ. A review of patents on effervescent granules. E-J Pharmaceut Rev. 2004;2. Available at http://www.pharmainfo.net/reviews/review-patents-effervescent-granules. Accessed March 23, 2010.

  34. Logemann JA. Evaluation and treatment of swallowing disorders. 2nd ed. Austin, TX: Pro-Ed; 1998.

    Google Scholar 

  35. Kim Y, McCullough GH, Asp CW. Temporal measurements of pharyngeal swallowing in normal populations. Dysphagia. 2005;20:290–6.

    Article  PubMed  Google Scholar 

  36. Kim Y, McCullough GH. Stage transition duration in patients poststroke. Dysphagia. 2007;22:299–305.

    Article  PubMed  Google Scholar 

  37. Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, Maxwell R, Blair J. MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia. 2008;23:392–405.

    Article  PubMed  Google Scholar 

  38. Rosenbek JC, Robbins J, Roecker EV, Coyle JL, Woods JL. A penetration-aspiration scale. Dysphagia. 1996;11:93–8.

    Article  PubMed  CAS  Google Scholar 

  39. Eisenhuber E, Schima W, Schober E, Pokieser P, Stadler A, Scharitzer M, et al. Videofluoroscopic assessment of patients with dysphagia: pharyngeal retention is a predictive factor for aspiration. Am J Roentgenol. 2002;178:393–8.

    Google Scholar 

  40. Jones LV, Peryam DR, Thurstone LL. Development of a scale for measuring soldiers’ food preferences. Food Res. 1955;20:512–20.

    Google Scholar 

  41. Krosnick JA, Tahk A. The optimal length of rating scales to maximize reliability and validity. Available at http://comm.stanford.edu/faculty/krosnick/. Retrieved February 1, 2010.

  42. Daniels SK, Schroeder MF, McClain M, Corey D, Rosenbek JC, Foundas AL. Dysphagia in stroke: development of a standard method to examine swallowing recovery. J Rehabil Res Dev. 2006;43:347–56.

    Article  PubMed  Google Scholar 

  43. Daniels SK, Schroeder MF, DeGeorge PC, Corey DM. Defining and measuring dysphagia following stroke. Am J Speech Lang Pathol. 2009;18:74–81.

    Article  PubMed  Google Scholar 

  44. Corbin-Lewis K, Liss JM, Sciortino KL. Clinical anatomy and physiology of the swallow mechanism. Clifton Park, NY: Thomson Delmar Learning; 2005.

    Google Scholar 

  45. Dessirier JM, Simons CT, O’Mahony M, Carstens E. The oral sensation of carbonated water: cross-desensitization by capsaicin and potentiation by amiloride. Chem Senses. 2001;26:639–43.

    Article  PubMed  CAS  Google Scholar 

  46. Dessirier JM, Simons CT, Carstens MI, O’Mahony M, Carstens E. Psychophysical and neurobiological evidence that the oral sensation elicited by carbonated water is of chemogenic origin. Chem Senses. 2000;25:277–84.

    Article  PubMed  CAS  Google Scholar 

  47. Green BG. The effects of temperature and concentration on the perceived intensity and quality of carbonation. Chem Senses. 1992;17:435–50.

    Article  CAS  Google Scholar 

  48. Hewson L, Hollowood T, Chandra S, Hort J. Gustatory, olfactory and trigeminal interactions in a model carbonated beverage. Chemosens Percept. 2009;2:94–107.

    Article  Google Scholar 

  49. Yau NJN, McDaniel MR. The effect of temperature on carbonation perception. Chem Senses. 1991;16:337–48.

    Article  Google Scholar 

  50. Sasaki CT, Leder SB. Comments on selected recent dysphagia literature. Dysphagia. 2008;23:208–12.

    Article  Google Scholar 

  51. Simons CT, Dessirier JM, Carstens M, O’Mahony M, Carstens E. Neurobiological and psychophysical mechanisms underlying the oral sensation produced by carbonated water. J Neurosci. 1999;19:8134–44.

    PubMed  CAS  Google Scholar 

  52. Bradley RM. Sensory receptors of the larynx. Am J Med. 2000;108:47S–50S.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank the 17 people who participated in this study, the speech-language pathologist who provided reliability data, and Dr. Nikolao Tsigili, Aristotle University, who aided in the statistical analysis of the data.

Author information

Authors and Affiliations

  1. Department of Clinical Speech & Language Studies, Trinity College Dublin, Dublin 2, Ireland

    Katerina Sdravou & Margaret Walshe

  2. X-ray Department, General Hospital “G. Papanikolaou”, Thessaloniki, Greece

    Lukas Dagdilelis

  3. Kardia, P.O. Box 161, 57500, Thessaloniki, Greece

    Katerina Sdravou

Authors
  1. Katerina Sdravou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Margaret Walshe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lukas Dagdilelis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katerina Sdravou.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sdravou, K., Walshe, M. & Dagdilelis, L. Effects of Carbonated Liquids on Oropharyngeal Swallowing Measures in People with Neurogenic Dysphagia. Dysphagia 27, 240–250 (2012). https://doi.org/10.1007/s00455-011-9359-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-011-9359-8

Keywords

Search

Navigation